Provider Demographics
NPI:1487845905
Name:BRENNAN, ANDREA JORDAN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JORDAN
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 CONTINENTAL AVE
Mailing Address - Street 2:APT. 116
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-4023
Mailing Address - Country:US
Mailing Address - Phone:773-334-5317
Mailing Address - Fax:
Practice Address - Street 1:1803 CONTINENTAL AVE
Practice Address - Street 2:APT. 116
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-4023
Practice Address - Country:US
Practice Address - Phone:773-334-5317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist